Prior to COVID-19, there were already increasing rates of youth with mental health concerns, including an increase in youth presenting to medical emergency departments (EDs) with mental health chief complaints and limited access to treatment. This trend worsened during the pandemic, and rates of youth presenting to medical EDs with suicidal ideation and self-harm increased 50% from 2019 to 2022. This resulted in a \"boarding\" crisis, in part, due to a lack of inpatient psychiatric hospitalization beds, and many youth were left without access to adequate treatment. Additional study of innovations in health care delivery will be paramount in meeting this need.

Recent advances in psychiatric genetics have enabled the use of polygenic risk scores (PRS) to estimate genetic risk for psychiatric disorders. However, the potential use of PRS in child and adolescent psychiatry has raised concerns. This study provides an in-depth examination of attitudes among child and adolescent psychiatrists (CAP) regarding the use of PRS in psychiatry. We conducted semi-structured interviews with U.S.-based CAP (n = 29) who possess expertise in genetics. The majority of CAP indicated that PRS have limited clinical utility in their current form and are not ready for clinical implementation. Most clinicians stated that nothing would motivate them to generate PRS at present; however, some exceptions were noted (e.g., parent/family request). Clinicians spoke to challenges related to ordering, interpreting, and explaining PRS to patients and families. CAP raised concerns regarding the potential for this information to be misinterpreted or misused by patients, families, clinicians, and outside entities such as insurance companies. Finally, some CAP noted that PRS may lead to increased stigmatization of psychiatric disorders, and at the extreme, could be used to support eugenics. As PRS testing increases, it will be critical to examine CAP and other stakeholders\' views to ensure responsible implementation of this technology.

OBJECTIVE: The objective of this pilot study was to sample early career child and adolescent psychiatrists (EC CAP), Child and Adolescent Psychiatry (CAP) fellows, adult residents, and medical students to identify factors affecting recruitment to CAP fellowship.
METHODS: A 25-item questionnaire was sent to all adult psychiatry, CAP fellowship, triple-board residency program directors, and coordinators in the US to disseminate to their trainees. Questionnaires also were disseminated via professional groups on social media, and through psychiatry student interest groups to medical students.
RESULTS: A total of 369 people responded, of which 315 questionnaires were evaluable. Approximately half of the respondents were CAP fellows or EC CAP. Most decided to pursue a career in child psychiatry during medical school. Forty-three percent owed more than $200,000 in educational debt. The top reasons for pursuing a career in child and adolescent psychiatry included working with children, finding it to be a rewarding career, and finding it intellectually stimulating. A switch to a 1-year fellowship and higher income potential were noted to be factors that may increase consideration for CAP fellowship among those who chose not to pursue it.
CONCLUSIONS: The majority of early career child and adolescent psychiatrists were recruited during medical school, motivated by altruistic reasons. Early child psychiatry exposure, a means of addressing physician debt, providing additional incentives in geographically undesirable locations, and improving compensation, is needed to improve recruitment to this specialty.

The goal of our study was to describe the availability of community child and adolescent mental health services, trauma-informed care, and the geographic accessibility of these services for juvenile justice-involved (JJ) youth who received mental health services while in secure detention. Data collection occurred through direct contact with the child and adolescent outpatient clinics listed on the New York State Office of Mental Health website. Zip codes were collected from the juvenile secure detention census. Of the clinics contacted, 88.5 percent accepted JJ youth; however, 43.5 percent accepted them on a conditional basis. Only 62.1 percent offered trauma-informed care, including evidence-based interventions and unspecified care. Although 84.5 percent of the clinics that would accept this population reported currently accepting new patients, reported wait times were as high as six or more months. When JJ residents\' home zip codes and those of the clinics were geographically mapped, there were few clinics in the zip codes where most residents lived. The clinics that accepted youth on a conditional basis often refused high-risk patients, essentially ruling out a large majority of this population. The geographical inaccessibility of these clinics limits their ability to provide care for this vulnerable population.

OBJECTIVE: Although treatment non-adherence is relatively high among adolescents, there is a need for standardized measurement tools that measure adherence to treatment in adolescents. This study aimed to develop a new measurement tool to assess the adherence to treatment of adolescents with mental disorders who use psychotropic medication.
METHODS: The data of this methodologically designed study were collected between 01.04.2022 and 01.07.2023 in the Department of Child and Adolescent Psychiatry of a university hospital in the Aegean Region of Turkey. The Medication Adherence Reporting Scale and Adolescent Medical Adherence Scale draft form were used for data collection. The scale items were formed from the themes, sub-themes, and statements in the qualitative study that the researchers had conducted with adolescents with mental disorders and their parents, clinicians\' experiences, and systematic reviews and meta-synthesis in the literature. The study sample consisted of 95 adolescents with mental disorders. Exploratory factor analysis was performed with Varimax rotation to determine the factorial construct validity of the scale. Internal consistency analyses were performed in reliability analyses, and Cronbach\'s alpha coefficient was used.
RESULTS: The mean age of the adolescents was 14.18 years (1.81); 50.5% were male, and 96.8% were attending school. When the mental disorder diagnoses were analyzed, 65.3% of the adolescents were being followed up with Attention Deficit and Hyperactivity Disorder diagnoses, and 58.8% were using stimulants. The 12-item form of the Adolescent Medical Adherence Scale was found to have a three-factor structure with item-total correlation values ranging between 0.26 and 0.66, and these factors were named functionality, responsibility in treatment, and medication adherence. Factor loadings ranged between 0.44 and 0.86, and the items explained 62.98% of the total variance. The internal consistency coefficients of the scale were between 0.69 and 0.83 for the subscales and 0.82 for the total scale.
CONCLUSIONS: Based on the analysis and results used in this study, the Adolescent Medical Adherence Scale is a valid and reliable new measurement tool.
CONCLUSIONS: This tool can be used in clinical settings to evaluate adolescents\' treatment adherence and prognosis. Clinical studies conducted with adolescents can also determine adherence to treatment and affecting factors.

In this contribution, we discuss criteria for the quality of qualitative research. We consider reliability and validity as specifications of the comprehensive requirement for \'intersubjective replicability\', with which qualitative research should comply. In the data collection phase, \'argumentative\' reliability generally must suffice; in the data analysis phase, attention must also be given to \'technical\' reliability. Validation of qualitative research has to take place via three approaches: \'communicative\', \'critical\' or \'empirical\' validation. This clarifies the relative validity or \'authenticity\' of qualitative research.

BACKGROUND: Home treatment in child and adolescent psychiatry offers an alternative to conventional inpatient treatment by involving the patient\'s family, school, and peers more directly in therapy. Although several reviews have summarised existing home treatment programmes, evidence of their effectiveness remains limited and data synthesis is lacking.
METHODS: We conducted a meta-analysis on the effectiveness of home treatment compared with inpatient treatment in child and adolescent psychiatry, based on a systematic search of four databases (PubMed, CINAHL, PsychINFO, Embase). Primary outcomes were psychosocial functioning and psychopathology. Additional outcomes included treatment satisfaction, duration, costs, and readmission rates. Group differences were expressed as standardised mean differences (SMD) in change scores. We used three-level random-effects meta-analysis and meta-regression and conducted both superiority and non-inferiority testing.
RESULTS: We included 30 studies from 13 non-overlapping samples, providing data from 1795 individuals (mean age: 11.95 ± 2.33 years; 42.5% female). We found no significant differences between home and inpatient treatment for postline psychosocial functioning (SMD = 0.05 [- 0.18; 0.30], p = 0.68, I2 = 98.0%) and psychopathology (SMD = 0.10 [- 0.17; 0.37], p = 0.44, I2 = 98.3%). Similar results were observed from follow-up data and non-inferiority testing. Meta-regression showed better outcomes for patient groups with higher levels of psychopathology at baseline and favoured home treatment over inpatient treatment when only randomised controlled trials were considered.
CONCLUSIONS: This meta-analysis found no evidence that home treatment is less effective than conventional inpatient treatment, highlighting its potential as an effective alternative in child and adolescent psychiatry. The generalisability of these findings is reduced by limitations in the existing literature, and further research is needed to better understand which patients benefit most from home treatment.
BACKGROUND: Registered at PROSPERO (CRD42020177558), July 5, 2020.

In 1919, Shoma Morita established Morita therapy, and this method of psychotherapy is widely used in Japan and across the world. With time, the medical indications of Morita therapy have expanded to include not only neurosis and anxiety disorders but other conditions as well. In modern times, Morita therapy has been used to treat adolescentneurodevelopmental disorders; however, it has not been widely covered in the English-language literature. In this report, a five-year course of treatment for a female patient with autism spectrum disorder (ASD) is presented. The patient exhibited dissociation, auditory hallucinations, overmedication, and wrist cutting, leading to multiple admissions to an adolescent ward. Over the treatment course, the symptoms of dissociation, self-harm, and auditory hallucinations disappear. Further, the patient was able to find a way to relate to society that was appropriate for her.

暂无摘要。

UNASSIGNED: Catatonia is a syndrome characterized by psychomotor and behavioral disturbances and is associated with a substantially increased mortality risk in adolescent patients. There is a dearth of published literature describing treatment strategies for pediatric patients with catatonia. This dual-case series will describe the treatment course of 2 adolescent patients with catatonia at our pediatric inpatient psychiatric facility.
UNASSIGNED: This case series presents 2 adolescent patients (a 17-year-old male and a 16-year-old female) who initially presented with worsening agitation and paranoia, later developing catatonia. Both patients required long durations of hospitalization and were treated with high-dose lorazepam before requiring the addition of electroconvulsive therapy (ECT).
UNASSIGNED: Treatment of pediatric patients with catatonia creates a significant burden on patients, families, and the healthcare system. Treatment with high-dose benzodiazepines is high risk, while ECT is both difficult to access and comes with its own risks. Both patients discussed are transitional age, meaning they will soon be young adults who will continue to require high-level psychiatric care. Psychiatric pharmacists have a large role to play in ensuring safe medication management for these complex patients.
UNASSIGNED: This case series of 2 adolescent patients with catatonia demonstrates marginal reduction in symptoms with high-dose lorazepam in conjunction with ECT, with minimal side effects. This case series adds to the limited available literature regarding treatment of catatonia in pediatric patients and highlights the need for further study into effective treatment alternatives.